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    Dukungan Nutrisi Pra / Pasca Bedah

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    Afdhal Putra Restu Yendri
    Here are the key steps in developing a nutrition plan for this patient: 1. Calculate energy needs using Harris-Benedict equation with a stress factor of 1.2-1.3 given multiple trauma. Aim for 25-30 kcal/kg IBW. 2. Provide 1.5-2.0 g protein/kg IBW or 20-25% of calories from protein to support anabolism. 3. Initiate early enteral nutrition via NG tube at a slow rate of 20-30 ml/hr, advancing as tolerated to goal rate within 48-72 hours. 4. Monitor for refeeding syndrome given low albumin. Provide phosphorus and magnesium supplementation as needed.

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    Dukungan Nutrisi Pra / Pasca Bedah

    Uploaded by

    Afdhal Putra Restu Yendri
    84 views22 pages
    Here are the key steps in developing a nutrition plan for this patient: 1. Calculate energy needs using Harris-Benedict equation with a stress factor of 1.2-1.3 given multiple trauma. Aim for 25-30 kcal/kg IBW. 2. Provide 1.5-2.0 g protein/kg IBW or 20-25% of calories from protein to support anabolism. 3. Initiate early enteral nutrition via NG tube at a slow rate of 20-30 ml/hr, advancing as tolerated to goal rate within 48-72 hours. 4. Monitor for refeeding syndrome given low albumin. Provide phosphorus and magnesium supplementation as needed.

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    Diet Pra Pasca Bedah

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    Here are the key steps in developing a nutrition plan for this patient: 1. Calculate energy needs using Harris-Benedict equation with a stress factor of 1.2-1.3 given multiple trauma. Aim for 25-30 kcal/kg IBW. 2. Provide 1.5-2.0 g protein/kg IBW or 20-25% of calories from protein to support anabolism. 3. Initiate early enteral nutrition via NG tube at a slow rate of 20-30 ml/hr, advancing as tolerated to goal rate within 48-72 hours. 4. Monitor for refeeding syndrome given low albumin. Provide phosphorus and magnesium supplementation as needed.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    84 views22 pages

    Dukungan Nutrisi Pra / Pasca Bedah

    Uploaded by

    Afdhal Putra Restu Yendri
    Here are the key steps in developing a nutrition plan for this patient: 1. Calculate energy needs using Harris-Benedict equation with a stress factor of 1.2-1.3 given multiple trauma. Aim for 25-30 kcal/kg IBW. 2. Provide 1.5-2.0 g protein/kg IBW or 20-25% of calories from protein to support anabolism. 3. Initiate early enteral nutrition via NG tube at a slow rate of 20-30 ml/hr, advancing as tolerated to goal rate within 48-72 hours. 4. Monitor for refeeding syndrome given low albumin. Provide phosphorus and magnesium supplementation as needed.

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    DUKUNGAN NUTRISI

    PRA / PASCA BEDAH

    Dr. Zaimah Z. Tala, MS, SpGK


    Departemen Ilmu Gizi
    Fakultas Kedokteran
    Universitas Sumatera Utara
    PERANAN NUTRISI

    Kekhususan:

    Operasi stres + kelainan prabedah


    Salah satu penentu keberhasilan operasi
    Status nutrisi mortalitas dan morbiditas
    Status nutrisi adekuat kebutuhan nitrogen
    dan substrat energi terjaga
    PERUBAHAN TUBUH PASIEN PENYEBAB
    MALNUTRISI
    Nafsu makan berkurang, anoreksia
    Gangguan pencernaan, mal-absorbsi
    Kehilangan meningkat : luka, drainase
    Hiperkatabolisme
    Sintesa protein dan anabolisme menurun

    INFEKSI GAGAL ORGAN KANKER


    Metabolic response to trauma :
    Ebb phase

    Characterized by hypovolemic shock


    Priority is to maintain life / homeostasis

    - cardiac output
    - oxygen consumption
    - blood pressure
    - tissue perfusion
    - body temperature
    - metabolic rate
    Metabolic response to trauma :
    Flow phase

    cathecolamines
    glucocorticoids
    glucagon
    release of cytokines, lipid mediators
    Acute phase protein production
    Metabolic response to trauma

    Fatty deposit fatty acid

    Endocrine Liver & muscle glucose


    Response (glycogen)

    Muscle aminoacid
    (amino acid)
    Determining calorie requirements

    Indirect calorimetry

    Harris Benedict x stress factor x activity factor


    men : 66.47 + (13.75Wkg) + (5Hcm) (6.76Ayr)
    women : 655.1 + (9.56Wkg) + (1.85Hcm) (4.67Ayr)

    Rule of thumb :
    25 30 kcal / kg BW / day
    Metabolic response to trauma : stress factor

    Injury Stress factor


    Minor surgery 1.00 1.10
    Long bone fracture 1.15 1.30
    Cancer 1.10 1.30
    Peritonitis / sepsis 1.10 1.30
    Severe infection / multiple trauma 1.20 1.40
    Multi-organ failure syndrome 1.20 1.40
    Burns 1.20 2.00

    Activity Activity factor


    Confined to bed 1.20
    Out of bed 1.30
    Metabolic response to overfeeding

    Hyperglycemia
    Hypertriglyceridemia
    Fatty liver
    Hypophosphatemia
    Hypomagnesemia
    Hypokalemia
    Macronutrients during stress

    Carbohydrate

    - at least 100 g/day needed to prevent


    ketosis
    - Carbohydrate intake during stress should
    be between 30 40 % of total calories
    - glucose intake should not exceed 5
    mg/kg/mt
    Macronutrients during stress

    Fat

    - provide 20 35% of total kalories


    - max recommendation for iv lipid infusion :
    1.0 1.5 g/kg/day
    - monitor TG level to ensure adequate lipid
    clearance
    Macronutrients during stress

    Protein

    - req range from 1.2 2.0 gr/kg/day


    - comprise 20 30% of total calories
    during stress
    Determining protein req for hospitalized
    patients

    Stress level No stress Moderate stress Severe stress

    Calorie : N ratio > 150 : 1 150 100 : 1 < 100 : 1

    % protein / total cal < 15 % P 15 20% P > 20 % P

    P / kg BW 0.8 1.0 1.2 1.5 2.0


    g/kg/day g/kg/day g/kg/day
    Enteral nutrition
    - oral supplements
    - tube feeding

    Parenteral nutrition
    - total
    - peripheral
    Improved patient outcome

    Improved wound healing


    Decreased risk of complications

    - nosocomial infection
    Decreased length of stay
    Decreased healthcare costs
    zzt 0506
    Case problem
    B.C., a 40 yrs old white male is admitted to the hospital
    following multiple trauma injury. The patient is
    hemodynamically stable and a nasogastric suction tube
    is place due to the presence of gastric ileus. Drainage is
    approximately 1.2 L/day. There is no major organ
    dysfunction. His preinjury BW was 70 kg and his height
    is 178 cm. Selected biochemistries are :
    - serum sodium, mEq/L 135 (N=135 145)
    - serum potassium, mEq/L 4.8 (N= 3.7 5.0)
    - BUN, mg/dL 25 (N= 5 25)
    - glucose, mg/dL 130 (N= 80 110)
    Compute total daily energy need
    Compute total daily water need (including
    replacement for NG loss)
    Compute total daily protein need
    Initial nutrition therapy plan
    E.W., a well developed 25 year old male was admitted
    to the surgical ICU with a diagnosis of multiple trauma
    secondary to a motor vehicle accident. On examination
    patient was found to have a GCS of 8 with respiratory
    depression. The patient was hypotensive (90/60) and
    tachycardic (120x). Abdomen was not distended and
    bowel sounds were present but diminished . A NGT was
    placed with a return of 580 ml of clear gastric juice. A
    left femur fx and multiple superficial contusions and
    abrasions were noted with no evidence of severe
    external bleeding. The pat was placed on a ventilator
    and resuscitated. Hemodynamic stabilization was
    achieved with iv fluids and 2 units of PRC
    Blood chemistry data :
    - KGD 136 (80-110)
    - BUN 35 (5-25)
    - Cr 1.1 (0.5-1.2)
    -P 4.6 (2.5-4.5)
    - Ca 7.8 (8-11)
    - Total protein 6.2 (6.5-8.5)
    - alb 2.8 (3.5-8.5)
    - alk fos 540 (60-220)
    - CPK 800 (30-220)
    - Ht 36% (41-50%)
    - WBC 13.2 (3.8-9.8)
    The family, with whom the pat lives, said that the pat
    ate a normal diet. They denied any knowledge or
    observation of recent change in weight, appetite or
    eating habits.
    Body comp : strong muscular development suggested
    that the pat participated regularly physical act. Mildly
    increase abdominal adiposity was also present
    H 183 cm
    W 97 kg
    Ideal BW 83 kg
    BMI 28
    Post resuscitation weight 102 kg

    Nutrition plan ?

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